Are Face Transplants Ethical?
By Rahul Gladwin
University of Health Sciences Antigua
School of Medicine
So what is a face transplant?
Have you seen the movie Face-Off starring
Nicholas Cage and John Travolta? This
fantasy movie provides a glimpse into the
futuristic world, where face transplants would
be a norm. Currently, however, doctors
across the world are only beginning to fully
understand and carry-out this complex and
questionable procedure.
Why are face transplants unique?
Face transplants are unique because, unlike a kidney
transplant or a heart transplant, face transplants are
not necessary and are performed solely due to
cosmetic reasons. A disfigured face is not a life
threatening situation. Another consideration is that
face transplants are very new; no one knows how
the body will react to a rejected face, or what are the
long-term effects of taking anti-rejection drugs for
face transplants.
World’s first face transplant
The world’s first full-face transplant was
performed in 1994 by Dr. Abraham Thomas,
M.D., one of India’s prominent
microsurgeons. This wasn’t a movie, but a
real surgery to save the life of a nine-year-old
girl, who’s face was destroyed due to a
lawnmower accident, and surgeons simply
reattached the girl’s original face. This
surgery was inspired by previous failed
attempts by US and British surgeons.
Face transplant from donor
The world’s first partial face transplant from donor to
acceptor was performed in November 2005 by a
team of French surgeons led by Professor JeanMichel Dubernard. This was performed on a women
who’s face was mangled by a dog. Surgeons took a
triangular piece of face tissue from a brain-dead
donor’s nose and mouth, and grafted it onto the
patient’s face. This complex procedure was
performed within one month of the accident.
So what’s the problem?
The surgery performed by Professor JeanMichel Dubernard has raised important
ethical questions considering the fact that he
took the nose and mouth pieces from a braindead patient – with the permission of the
patient’s family of course. Medical ethicists,
including the French ethics panel, raise
questions that it is unnecessary to perform
face transplants – a high risk procedure –
only for the sake of cosmetic reasons.
Surgeons hit back
Professor Jean-Michel Dubernard stated that
the woman’s face couldn’t not have been
repaired using regular surgery, and even if it
was repaired, it would have rendered her
unable to eat, drink and speak. Furthermore,
the benefits of a face transplant clearly
outweigh the risks involved. Without a face, a
patient would lead a life of depression and
isolation, and have a high tendency to
commit suicide.
But risks are high
Patients, who have undergone face transplants,
have to spend the rest of their lives on high
doses of immunosuppressant drugs, that also
increase the risk of cancer, while the risk of
rejection lasts a lifetime. Patients take these
drugs to ensure their bodies don’t reject the
newly transplanted facial tissue.
Did French government agree?
No it didn't. The French government ethics panel is
against the procedure of face transplants. They say
this woman’s case was classified as an emergency
procedure, and face transplants, and informed
consents are inappropriate during emergency
procedures. Dr. Laurent Lantieri from the French
ethics panel further questioned the preparedness of
the patient for such a costly and demanding
procedure, and the burden of depending upon
complex drugs for the rest of her life in order to
make this operation a success.
The Question of Self-Image
Some ethicists questioned whether the woman was
prepared to live with someone else’s face on, and
how would it reflect on her self-image. Will she look
like the donor? Will she look like her original self? Or
will she look like a hybrid? The truth is, no one knew
what the patient will feel like, or how will she look
like. The BBC, however, reported that the patient will
look like a hybrid because the shape of the face
depends upon the underlying bone structure.
The question of personality
Humans recognize each other by their faces, and
exchange emotions by facial expressions. If we
change the face of a person, does the person
become someone else? According to researchers,
patients who have undergone hemispheroctomines
(removal of half the brain) still retain their presurgery personalities. This means that one’s
personality has little or nothing to do with ones body
organs. A person with a new face will still be the old
self with a new body organ.
Where does the US stand?
Face transplants will hopefully be offered by US
surgeons and psychologists at two medical centers:
Cleveland Clinic and the University of Louisville. Dr.
Maria Siemionow from the Cleveland Clinic stressed
that surgeons shouldn’t be discouraged or stopped
by doing new surgeries. "I hope nobody will be
frivolous or do things just for fame. We are almost
over-cautious," she said at the time. This high-risk
procedure does require doctors to ensure that
patients have given valid consent.
What does the future hold?
A relatively new area of medicine called Tissue
Engineering will enable people to design
their own faces, replace their existing faces
with the new one, all done quickly and
affordably. It means that if you don’t like your
baggy eyes or those wrinkles on your
forehead, you could visit your local beauty
salon and get a new face in ten minutes right
before the Friday night party. The question is:
is this morally ok?
No, it is not morally OK
I feel that face transplants should only be used
on patients who have injured or mangled their
faces, and not on patients who want to get rid
of their wrinkles or bags under their eyes. I
feel that having a face transplant solely for
the purpose of making one look attractive in
middle age is very different from having a
face transplant for protecting one from a life
of depression, loneliness and low selfesteem.
Bibliography & Links
Links:

http://health.discovery.com/centers/plasticsurgery/facetransplant/slid
eshow/slide.html

http://www.washingtonpost.com/wpdyn/content/article/2005/12/02/AR2005120201787.html

http://www.cbsnews.com/stories/2005/12/01/health/main1091293.sh
tml

http://www.iht.com/articles/2004/06/16/edsokol_ed3_.php